In 2008, the Advisory Committee on Immunization Practices (ACIP) expanded recommendations for yearly influenza vaccination to include all children 6 months to 18 years. Achieving high influenza coverage rates for all children will require a substantial increase in primary care visits and, potentially, changes in delivery practices both at the level of the practice and the health care system. In the current proposal, a study team with extensive experience in immunization delivery research will investigate the feasibility and effectiveness of innovative office-based and private-public collaborative strategies for the delivery of influenza vaccine to children in different practice settings. The study will include four types of clinical settings including urban pediatric and urban family medicine practices, urban managed care organization (MCO) sites and rural family medicine practices. Groups of similar practices within each of these practice types and clinical settings will be recruited and randomized to either intervention or control arms. During the first year of the grant, focus groups will be conducted among parents at intervention sites to assess the feasibility and acceptability of various strategies to promote influenza vaccination. In collaboration with the study team, and informed by patient attitudes and preferences, intervention practices will develop office-based interventions including methods to identify high-risk patients within their practices and methods of maximizing the immunization of these children within the practice, use of patient reminders, after-hours influenza clinics, walk-in provision of influenza vaccine and increased focus on education regarding the need for immunization. The practices will also collaborate with their county public health departments and visiting nursing associations to develop private-public collaborative interventions that may include large clinics for school-aged children for multiple practices and tracking of influenza supplies and redistribution of influenza vaccine between practices when supplies are delayed or inadequate. During the second year, we will conduct a group-randomized trial to determine the effectiveness of the immunization delivery program. The study team will track important process measures during implementation of both the office-based and private-public interventions in order to determine the degree to which implementation was successful and to identify impediments to success. We will also conduct structured interviews in the intervention practices and the participating public health departments to assess provider and staff perceptions regarding barriers to private-public collaborative delivery in their settings and means of improving the process. Finally, in two intervention practices we will examine parental attitudes about the office-based and private-public collaborative interventions that were implemented. Qualitative data obtained at the end of year 2 will be used to modify the intervention in year 3 and data obtained in year 3 will assess the sustainability of the interventions. PUBLIC HEALTH RELEVANCE: Expansions in the Advisory Committee on Immunization Practices (ACIP)'s 2008 recommendations for influenza vaccination to include all children 6 months to 18 years has dramatically increased the volume of children primary care providers need to vaccinate on a yearly basis. This project will assist recruited practices in the development of innovative practice-based and private-public collaborative interventions aimed at achieving high rates of influenza coverage among children in the practices. The effectiveness, feasibility, and sustainability of these interventions will then be tested using a cluster-randomized design in four types of practice settings, urban pediatric, urban family medicine, urban managed care organization and rural family medicine practices.